BROOKSVILLE — Citing a growing need for general patient services, and a particular need for those who are now under-served, Hospice of Citrus County last year pitched to the state its desire to expand into Hernando County.

But last month, as the deadline for challenges of the approval approached, the only other hospice provider in Hernando, HPH Hospice, filed a challenge. HPH cited a "lack of published numeric need'' and detailed how the Hernando organization would be damaged if the Citrus hospice group were allowed to expand.

The expansion would create an unnecessary duplication of services, hinder the ability to hire experienced clinical staff, cut revenue and hurt the ability to raise money, according to the complaint.

Stung by the challenge, Citrus hospice chief executive officer Anthony Palumbo wrote an open letter to the community. He asked why, when HPH wanted to expand into Citrus in the mid 2000s, it made the same argument that Citrus hospice is making now — that patient choice is vital and that having more than once provider is good for service.

There are several reasons why the Citrus hospice, which now operates under the name of Hospice of Citrus and the Nature Coast, wanted the certificate of need from the state to expand into Hernando County, said Bonnie Saylor, the organization's chief operating officer.

The need for services continues to grow in the area, Saylor said. Normally, once a district demonstrates a need for service for 350 or more patients, the state will award a certificate. Hernando's need is not there yet. But Saylor noted that the Citrus hospice sought approval because of the growth in need and other special circumstances.

In addition to its standard hospice services, the nonprofit organization operates a Partners in Care-Together for Kids program in 11 counties, including Citrus. That licensed program provides palliative care support for children and adolescents facing life-threatening conditions who don't qualify for normal hospice care.

The Citrus hospice does not provide medical care, but rather supportive care, for the ill children. That includes counseling, play, music and art therapies, respite care and other services.

At the urging of the Ocala medical provider with whom Citrus hospice partners on that program, Citrus hospice agreed recently to provide care for several Hernando children. But once the children were sick enough to qualify for hospice, the Citrus group could not continue.

Saylor pointed out that it is important in the work the group does to build a rapport with the family, and it would be good for the patients and their families if the same people worked with them throughout their illnesses and beyond, through grief counseling.

With a couple of the families served by the Citrus hospice, their experience with HPH was not what the parents had wanted for their children as they drew near the end of their lives, Saylor said. They wanted care in the home, she said, but HPH was more interested in having people stay in their hospice house.

In one case, a child was transferred to the Citrus hospice house to stay with familiar caregivers. In another, the child stayed home without standard hospice care and died in the hospital. In still another, Saylor said, HPH agreed to provide home care, but then never returned to provide the care or help siblings through their grieving process after the child died.

Without specific time frames or information about who the parents and patients were, HPH Hospice could not respond to those issues, said spokeswoman Robin Kocher.

"It's hearsay,'' she said.

The Citrus hospice is also interested in building a rapport with Hernando County nursing homes for patients who want to receive hospice services in that setting, Saylor said.

When the Times asked for comment from HPH about its administrative complaint challenging the Citrus hospice's certificate of need, the chairman of their board responded in writing.

"HPH Hospice has appealed the decision to approve Hospice of Citrus County's (HOCC) application for a Certificate of Need to serve Hernando County because we believe the decision was based on false claims made by HOCC,'' Randy Woodruff wrote. "We will be working with the Agency for Health Care Administration to defend our case through their established procedures.''

He would also not comment on some of what Saylor and the Citrus hospice application say about HPH.

"We are not responding to the allegations made by HOCC in their application because a public dispute is not a professional representation of the values or mission of hospice care and it only serves to undermine the community's faith in the organizations they depend on in a time of crisis,'' Woodruff wrote.

Saylor said she was working for HPH when a competitor moved into its Pasco territory. She said it made HPH better. She was working for the Citrus hospice when HPH became a competitor in Citrus County. The Citrus hospice got better, too, she said.

She said she believes the same would happen if her agency moves into Hernando County.

"If you have competition, the patient benefits,'' Saylor said. "Competition makes you better.''

Barbara Behrendt can be reached at behrendt@tampabay.com or (352) 848-1434.

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